Epidemiology and Impacts
Homelessness and its health effects represent well-known problems in the U.S. As for the epidemiology/prevalence, over 582,000 people, which is every 18 out of 100,000 U.S. citizens, experienced a lack of housing in 2022 (De Sousa et al., 2022). Regarding morbidity, homelessness predisposes individuals to cancer, substance abuse/overdose, and respiratory/cardiovascular conditions (Funk et al., 2022).
In the U.S., homelessness contributes to premature death, with mortality rates for this group being up to 16 times greater compared to non-homeless Americans. Overdosing linked to substance dependence causes up to 30% of deaths in the homeless population (Funk et al., 2022). Thus, the problem’s impacts on the U.S. population are enormous.
Intervention
The Housing First (HF) program represents a promising intervention to resolve the issue. There is some evidence of its economic feasibility, including healthcare cost optimization. Based on 20 HF evaluation studies conducted in the U.S., Jacob et al. (2022) assess the program’s benefit-cost ratio to reach 1,80:1, which suggests economic effectiveness. The cited evidence is relatively strong as it comes from a systematic appraisal of twenty high-quality studies, thus producing generalizable results.
The Know-Do Gap
The know-how gap can be described as the inability to reach non-veteran audiences adequately and prevent housing loss by HF participants. Although the intervention is adopted and used, certain categories of homeless Americans might struggle with accessing HF resources. Specifically, there is a lack of HF availability to serve non-veterans facing housing issues.
In 2023, 140,000 homeless people, including at least 90,000 veterans, accessed permanent housing via HF (National Low Income Housing Coalition, 2023). The number of veterans in need of housing has dropped from 73,000 to 33,000 between 2009 and 2022, so excessive reliance on services for this category might be unjustified (De Sousa et al., 2022). Furthermore, certain HF service recipients might fail to use the intervention correctly. For instance, in Hawaii, 12% of HF service users lose housing within five years (Lusk et al., 2022). There is no specific evidence for excessive money and resource use or life/health loss that occurs in service users despite accessing HF resources.
References
De Sousa, T., Andrichik, A., Cuellar, M., Marson, J., Prestera, E., & Rush, K. (2022). The 2022 Annual Homelessness Assessment Report (AHAR) to Congress. U.S. Department of Housing and Urban Development. Web.
Funk, A. M., Greene, R. N., Dill, K., & Valvassori, P. (2022). The impact of homelessness on mortality of individuals living in the United States: A systematic review of the literature. Journal of Health Care for the Poor and Underserved, 33(1), 457-477. Web.
Jacob, V., Chattopadhyay, S. K., Attipoe-Dorcoo, S., Peng, Y., Hahn, R. A., Finnie, R., Cobb, J., Cuellar, A. E., Emmons, K. M., & Remington, P. L. (2022). Permanent supportive housing with Housing First: Findings from a community guide systematic economic review. American Journal of Preventive Medicine, 62(3), e188-e201. Web.
Lusk, H. M., Shaku, D., Hemrajani, A., Leverenz, N., Moefu-Kaleopa, J., & Staley, A. F. (2022). Housing First: Harm reduction at the intersection of homelessness and substance use. Hawaii Journal of Health & Social Welfare, 81(12), 1-11. Web.
National Low Income Housing Coalition. (2023). The case for Housing First. Web.